Office Use Please mail Registration and make check payable to: Secretary of State Ken Bennett / Trade Name Division 1700 West Washington 7th Fl. Phoenix, Arizona 85007 Walk-in service: 14 N. 18th Ave., Phoenix, Arizona Tucson Office: 400 W. Congress, Ste. 252 (602) 542-6187 (800) 458-5842 (within Arizona) Filing Fee: $3.00
AMENDMENT TRADENAME TRADEMARK Do not use this form for a change of ownership. Please use an Assignment form for such a change. Please print clearly as renewal notices are dependent on this information. File Number: Trade Name or Trademark Description:
Owner Name(s): CHECK ALL THAT APPLY: Address Change. Former Address: New Address: Phone Number: Nature of Business:
Other:
Legal Name Change of Applicant. Former name: New name: Reason for name change (include copy): Marriage Divorce Other (Specify)
Applicant's Printed Name State of Arizona County of ______________
Applicant's Signature
On this ____ day of ________________, 20___, before me personally appeared ________________________________, (name of signer) whose identity was proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this document, and who acknowledge that he/she signed the above document. __________________________ Notary Public